The Registry and its reports are needed to identify
problems as early as possible. The NPA can then submit
its findings and seek appropriate assistance from experts
and governmental agencies including the Food and Drug
Administration (FDA).

NOTE: The NPA will not release your
personal data.
We do not sell or share personal information.
See our privacy policy for more
details.

Name:

Organization:(leave blank if
none)

Category:

Address:

Address:(continued)

City:

State:(US Only)

Zip
Code:

Phone:

E-Mail
Address:

How
Did You Find Us:

Date of
Outbreak:please enter in
MMDDYY format
example:
062598

Patient
Age:

Patient
Sex:

Male
Female

Where
did the outbreak occur?

Describe the type of outbreak (lice or scabies)
and provide any additional
notes:

Does your
community/organization have a head lice prevention program?

Yes

No

N/A

Have
you used a lice or scabies treatment that failed?

Yes

No

N/A

Has
a lice or scabies treatment caused you harm or made you ill?

Yes

No

N/A

Comments:

This "captcha" test is required to prevent automated spamming of our system.